Ethnic Identity and Eating Disorders

Not too long ago I heard the interesting cross-cultural story of a young India-born woman who developed an acute and life-threatening case of anorexia nervosa as a high school student in Canada. Her story illustrates how growing up an ethnic minority and negotiating two different cultures can be both a risk factor and a pathway to recovery.

The woman is now a retired doctor, yet as we conversed via a long-distance telephone call, the memory of that heart-wrenching time was still vivid for her. (Our paths crossed when I was introduced to the woman, who prefers to remain anonymous, by her cousin, a friend of mine in New York City.)

The recovered woman, whom I’ll call Alice, was born in Southern India and emigrated to Canada with her family at a young age. As the eldest of three daughters, she was the first in the family to have to juggle traditional Indian cultural expectations with the social code of her small-town Canadian public school.

An avid athlete, Alice ran track in high school, and traces the beginnings of her eating disorders to one comment made by her coach. “I remember him looking at us, and saying we have to eat better, cut out junk food,” recalls Alice. “I thought he was talking to me personally, and that kind of set off this whole thing.”

It wasn’t just that one comment, though. “I wanted to be accepted in the West,” Alice adds. Although she was already thin to begin with, she thought “the thinner I am, maybe the more accepted I will be.” Looking back, she believes her disorder was complicated by the nature of her relationship with her parents and the cultural disconnect that all immigrant families face. “There were control issues with my parents,” says Alice. “They were very loving,” she recalls, but pushed traditional Asian values of modesty and hard work especially firmly with their eldest daughter. It was hard for them to adjust to the western world of dances, revealing fashions and boys, not to mention the youthful rebellion of the late ‘60s and early ’70s. Not that Alice ever got into trouble; instead, she threw herself into the traditional activities of the ambitious Canadian high schooler, student government and sports.

Alice ran and ran and didn’t eat much. Within a year-and-a-half, her weight had plummeted by 40 percent. Her periods stopped, her hair fell out, yet she recalls, “I thought I was fat. People would tell me ‘You’re thin,’ and I’d think, ‘Oh, they’re jealous.’” Alice was hospitalized for four months, during which she was force-fed hourly and only allowed to get out of bed and walk around if she showed continued weight gain. Her doctor told her parents that if they had waited a few more days before seeking treatment Alice would not have been alive. “As I gained weight, I started getting more rational and realized how sick I’d been,” she recalls.

Her mother decided she needed to get away from western influences and took Alice to India for a year. Alice credits being away from negative media images of women as well as her love of sports for getting her healthy again. In India, she was surrounded by her extended family and in a culture where size and shape was not as emphasized. “I had done sports all my life and had gotten into playing semi-competitive squash in university,” she says. She realized that severely underweight athletes can't compete.

The experience helped propel Alice into a career as a primary care physician in Canada, where she focused on preventive health, nutrition and fitness. Today, nearly 40 years later, she maintains a normal weight, runs, swims and eats balanced meals.Her advice to others: "Recovery from a severe eating disorder is not only possible, but can be followed by a happy and fulfilling life. The key is to acknowlege you have a problem, trust that your loved ones have your best interests at heart and, above all, seek professional help."

I hope Alice’s story helps those of you who are now in the throes of an eating disorder realize that you too, whether you come from a minority culture or not, can recover. Focusing on the things that you used to love to do and your desire to do them again can be a very effective tool in your recovery, as can a supportive family or close friends.

There are many ways that a family can be supportive: by being willing to listen, being non-judgmental, learning how to be a positive, active presence during mealtimes, and to help implement and maintain a food plan buy shopping for ingredients for it, preparing and/or encouraging the consumption of regular meals and snacks, and helping the eating-disordered person remember that relapses are normal and that it is long-term progress that matters.

For more on ways family and friends can be supportive I suggest you read our book, "The Parent's Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home."

Nancy,
I would go a step further and say that if a child or adolescent is suffering from anorexia nervosa, the parents should not merely "encourage" the consumption of regular meals and snacks, they should insist on it. The parents should see AN as an illness that has temporarily created an emergency and robbed the young person of the ability to make sensible decisions about eating. The parents should take control, temporarily, and actively feed their kid back to health, without compromise or negotiation.
This is the basis of the Maudsley model of Family Based Treatment, the model that has the strongest base of scientific evidence and the one recommended by virtually all the leading researchers, including those at the National Institute of Mental Health and the American Academy of Pediatrics.
The semi-starvation associated with AN causes damage to the sufferer's brain on a daily basis and should be addressed early and aggressively. The longer AN is allowed to persist, the greater the likelihood that the damage to the brain will be permanent.